HomeMy WebLinkAboutInsurance Certificate: Bertocchi Builders STATE FARM INSURANCE COMPANIES'
DATE OF NOTICE: JUL 10 2013
PO BOX 5000 CODE:
Dupont WA 9B327-5000
78A
AT1 15 A
000755 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
20 E MAIN ST
ASHLAND OR 97520-1850 OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
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ADDITIONAL INSURES NOTICEiOF COVERAGE
State Farm Mutual Automobile Insurance Company 9A13-FAE6H
NAMED INSURED: POLICY NO: 0026612-F22-37N COVERAGE:
°e ,BERT000HI, MARK YR/MAKE/MODEL: 2005 CHEVROLET PICKUP BI AND PD LIABILITY
DBA BERTOOCHI BUILDERS VIN/CAMPER: 1 GCHK23235FB47007 $01i$50,000
MP.
1860 GABRIEL WAY AGENT NAME: JON SNOWDEN $22550 D ED. COOMP.
$1000 DED. COLL.
i MEDFORDOR 97501-4154 AGENTPHONE: (541)482-2461
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
r JUL 08 2013 UNTIL TERMINATED
POLICY MESSAGES:
R The policy Includes a loss payable clause protecting the additional Insured's interest in the described car to the e)dent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice
v~ is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
iN4 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
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